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The major difference between cycles 1-2 and the third one is the absence of Lupron. Apparently, you respond better without Lupron. Some folks do and it looks like you're one of them. You new doctor gavit a try without Lupron and you had a better (more physiological) stimulation that resulted in better embryo development. Embryos at the compacted morula stage on Day 5 are within the expected range. When we observe this in our program, we wait until the morning of Day 6 to be sure they have reached the blastocyst stage before transferring them. They usually do, so no harm was done by transferring them on Day 5 at the compacted morula stage. However, the 8-cell had arrested, so there was no point to transferring that embryo.

It has been my experience (and that of others) that assisted hatching of blastocyst stage embryos immediately prior to transfer improves implantation rate.

The developmental potential of eggs cannot be assessed by just looking at the them. Hence, chosing the "best" eggs by their appearance is misleading. Your ICSI results make my point. The developmental potential of eggs lies in their genetic normalicy which cannot be determine by looking at them at the time of ICSI or insemination.

Dr. Smith,
Thank you for your response. I will discuss this with my doctor. I have a few more questions - Can you do AH with a day 5 compacted morula? Can AH damage the embyros? Is it typical for a clinic to wait for a day 6 transfer if the embryos havent reach the blastocyst stage? If the embryos are at the morula stage on day 5, what is the likelihood they will make it to the blastocyst stage? And if they dont make it to the blast stage is there a typical reason why? Also, if you dont mind me asking, what clinic are you with? I am also in NYC. I appreciate your response. Thanks again.

We tried our first IVF in Jan. BFN. I am 31, DH is 36 with low sperm count. We had 19 eggs retrieved. Used Follistem. 6 eggs were mature day 1 and were ICSI. 5 more matured on day 2 and were ICSI. Total of 11 were fertilized. We did day 3 transfer of 3 emryos. 2 were only 4 cell division 1 was a 5 cell. The day 1 maturation eggs gave us our 3 embryos for transfer. The other 3 embryos were only a 2 cell division day3. The 2nd day mature eggs were also at around 3 and 4 cell divisions on day 3, 2 had some fragmentation. We ended up with 2 perfect blastocysts to freeze though out of these 11. RE was a little surprised with our outcome. This next cycle he is trying Lupron and we are waiting for blastocyst. From reading your other responses, it sounds like we stimulated too quickly and the eggs did not have time to go through all their phases of development. Do you aree?

Dr. Smith ~ I am 38 with history of endo/ovarian chocolate cysts/lap, dh is 41 (always has normal SA). We started ivf since I was 34 (we had 4 ivfs in total). We had first 2 ivfs in China since dh were on a 3 year business assigment there. We had 29-30 eggs retrived. 12-15 fertilized without icsi and we had 1-4 8-celled top grade embryos (no fragments) to transfer on day 3. Rests were slow growing ranging from 6-celled to 4-celled embryos (majority were in 6-celled stage on day 3). We got bfn on both attempts.

Last year, dh comes back and we tried 2 ivfs in a "top" clinic in the U.S. RE recommended icsi. So we went for it. 1st ivf there (3rd in total) we had 20 eggs retrived, 10 matured, 3 (two 8-celled, one 6-celled top grade) embryos transfered on day 3. bfn.

2nd ivf (4th in total） I was hyperstimulated (day 5 e2=2400). 14 eggs retrived, 6 mature, 3 made to day 3 transfer (one 7-celled with 40% fragmentation graded 3+, one 6-celled grade 4-, one 4-celled graded 4) (on 1-4 scale, 1 being worst, 4 being best).

My questions are,

1) By looking at my 4 ivfs history, is it normal for a person to have about 50% fertilization rate and besides of having 1-4 8-celled embryo, the rests are in 6-celled stage on day 3? Does it indicate egg quality problem?

2) As for my last (4th) ivf, do you think poor embryo development was due to hyperstimulation? This cycle RE increased LH to 150iu/day. I had this dose from beginning till end of stims. Previous cycles, RE only added LH to help my follicles to grew faster while I was on gonal f. Thanks.

Dr. Smith-We tried our first IVF in Jan. BFN. I am 31, DH is 36 with low sperm count. We had 19 eggs retrieved. Used Follistem. 6 eggs were mature day 1 and were ICSI. 5 more matured on day 2 and were ICSI. Total of 11 were fertilized. We did day 3 transfer of 3 emryos. 2 were only 4 cell division 1 was a 5 cell. The day 1 maturation eggs gave us our 3 embryos for transfer. The other 3 embryos were only a 2 cell division day3. The 2nd day mature eggs were also at around 3 and 4 cell divisions on day 3, 2 had some fragmentation. We ended up with 2 perfect blastocysts to freeze though out of these 11. RE was a little surprised with our outcome. This next cycle he is trying Lupron and we are waiting for blastocyst. From reading your other responses, it sounds like we stimulated too quickly and the eggs did not have time to go through all their phases of development. Do you aree?

Dr. Smith~I had done 4 ivfs. All were bfn. Me 38 and has history of endo/chocolate cysts/lap, dh 41 (alwyas has normal SA). Otherwise we are normal on all IF tests (FSH, LH, E2, PRL, TSH, TH, HSG, saline ultrasound, hystoscopy, APA, anti-sperm antibody, SA, chromosomal analysis/karyotyping etc.)

My questions are:

1) Previous 2 ivfs in China (dh had work assigment there for 3 years), I had 29/26 eggs retrieved, 15/12 eggs fertilized naturally and had 1/4 8-celled top grade embryos on day 3 transfer. Besides 8celled embryos, majority of my embryos are in 6celled stage on day 3. Do you think my embryos are slow growing?

2) My 3rd/4th ivfs were done in a "top" clinic in the U.S. last year. We did icsi due to previous 50% natural fertilization rate. We had 20/14 eggs retrived, 10/6 mature, and only 6/4 fertilized. 3rd ivf, on day 3 we had two 8celled top grade embryos, one 6celled top grade embryos to transfer. bfn. 4th ivf, I was hyperstimulated (e2=2400 on day 5) and on day 3 only had one 7celled (40% fragmentation) grade 3+ embryo, one 6celled grade 4- embryo, and one 4celled grade 4 embryo (1-4 scale, 1 being worst, 4 being best). bfn. Why I have worse fertilization rate with icsi? I know 4th cycle was not a bust. What impression do you have after reviewing all my ivfs. Do you think I have an egg issue? The "top" clinic in U.S. I went to, RE there gave me 65% succsee rate. Every RE I saw gave me very high chance of success, but how come ivf never worked, not even a chemical?

Thanks.

I know 4th cycle was a bust.

Dr. Smith-We tried our first IVF in Jan. BFN. I am 31, DH is 36 with low sperm count. We had 19 eggs retrieved. Used Follistem. 6 eggs were mature day 1 and were ICSI. 5 more matured on day 2 and were ICSI. Total of 11 were fertilized. We did day 3 transfer of 3 emryos. 2 were only 4 cell division 1 was a 5 cell. The day 1 maturation eggs gave us our 3 embryos for transfer. The other 3 embryos were only a 2 cell division day3. The 2nd day mature eggs were also at around 3 and 4 cell divisions on day 3, 2 had some fragmentation. We ended up with 2 perfect blastocysts to freeze though out of these 11. RE was a little surprised with our outcome. This next cycle he is trying Lupron and we are waiting for blastocyst. From reading your other responses, it sounds like we stimulated too quickly and the eggs did not have time to go through all their phases of development. Do you agree?

Hi Dr. Smith,

I just completed my IVF cycle # 2. In IVF#1 I used the lupron protocol. 11eggs were retrieved 6 were mature and 5 fertilized using ICSI. My RE decided a day 5 transfer was best because all 5 embryos were 8 celled on day 3. We ended up putting back two embryos (one a late morula and the other an early blast). That cycle ended in a negative.

Cycle #2 my protocol was adjusted to antagonist. 21 eggs were retrieved 18 mature and 16 fertilized using ICSI. I was advised again on day 3 that I would have transfer on day 5. All embryos were 8 celled on day 3. On day of transfer my doctor called to advise that all 16 of my embryos had arrested. At my consult we were advised that based on husband's poor sperm morphology that we may have paternal DNA issues. This would justify why our embryos arrested. I am 30 yrs old so doctor did not think that we had an egg issue. My husband took the SCSA test and his results were excellent sperm. My doctor called with the results and stated that based on husband's results that they think we now have egg issues.

Please let me know what you think based on my two cycles. Could it be possible that there was a lab error or that my embryos are better off in me on day 3 than stressed to grow to day 5 in dish? What would you recommend for cycle # 3?

Your opinion is much appreciated. Please be honest.

Thanks,
L

Embryonic arrest between Day 4 and Day 6 (as in your case) is usually associated with paternal DNA problems. The SCSA test examines DNA fragmentation, but does not test the actual genetic make-up of the sperm. There could still be problems with the sperm DNA that are not addressed by the SCSA test results.

Problems with the genetics of the egg can also cause this kind of embryonic arrest. Genetic problems with the eggs are associated with aging. You didn't post your age, so I'm not sure this is a factor.

From what you've said, your doctor seems very knowlegable. I think you should trust his opinion.

I don't suspect a lab "error". Problems in the lab don't cause embryos to arrest between Day 4 and Day 5. It looks like the problem is genetic (coming from either sperm or egg) and transferring the embryos to your uterus on Day 3 would not have changed the genetic make up of the embryos. If the embryos had been transferred on Day 3, you would know even less about your situation than you do now.

It is possible to test the "genetic problem" hypothesis through pre-implantation genetic diagnosis, but even PGD is not all together conclusive.

Dr. Smith-We tried our first IVF in Jan. BFN. I am 31, DH is 36 with low sperm count. We had 19 eggs retrieved. Used Follistem. 6 eggs were mature day 1 and were ICSI. 5 more matured on day 2 and were ICSI. Total of 11 were fertilized. We did day 3 transfer of 3 emryos. 2 were only 4 cell division 1 was a 5 cell. The day 1 maturation eggs gave us our 3 embryos for transfer. The other 3 embryos were only a 2 cell division day3. The 2nd day mature eggs were also at around 3 and 4 cell divisions on day 3, 2 had some fragmentation. We ended up with 2 perfect blastocysts to freeze though out of these 11. RE was a little surprised with our outcome. This next cycle he is trying Lupron and we are waiting for blastocyst. From reading your other responses, it sounds like we stimulated too quickly and the eggs did not have time to go through all their phases of development. Do you agree?

Yes, I think that's what happened. Ovarian stimulation is not an exact science and sometimes it requires some tweaking to get it right. Best of luck on your next try.

Hello Dr. Smith,

I just had my 2nd ivf cycle. In both cycles I had slow growing embryos. I was 39 at IVF #1 and 40 at ivf #2. I was diagnosed with Hypothryoidism (TSH 5.75) during infertility workup. Started on lowest dose of generic synthroid. TSH at 3.5 at start of IVF #1. IVF #1 had 9 eggs retrieved, 6 matured, 3 fertilized. Did a 3 day transfer of 3 4cell embryos. BFN. In between cycles, switched to name brand synthroid and doubled the dose. TSH dropped to 2.3. IVF #2, 9 eggs retrieved, 9 matured, 6 fertilized, 3 arrested by day 3 and 3 4cells were transferred on day 3. In both cycles I was on max stims (600 gonal-f on first cycle for 12 days and 450 follistim for 8 days on cycle 2). On cycle 2, my estrogen skyrocketed to 3000 by day 6 and coasted to day 8 ending at 4200. The two questions I have are: 1) could my hypothyroidism be causing the slow growing embryos. Note, double the fertilization rate with double the synthroid dosage. I wonder if I still need to fine tune meds. If get TSH to normal range for me (around 1-2) is it possible my embryos would grow normally? 2) Coud I be on too high of stimulation. I know they started me high because of my age, but I wonder if I need lower dose stims to start. I am very small, and have always been very sensitive to anything put in my body.

Thank you for your input.

Shari

I am not aware of any link between hypothtroidism and embryonic growth (fast or slow). Your other question is for an RE. Please post on Dr Jacob's Infertility 101 Message Board.

I just noticed my email was still there. I used the frozen
donor eggs and it did not work. I am done. I feel since
my 2 tubals and placent problems and birth at 6 months,
my body has never been the same. I was a slam dunk
on getting pregnant since I had been pregnant (7)so many
times on my own, but now I am giving up. I feel that no one has given me anything that makes sense? Yes it is
probably the sperm, maybe but can all these eggs + a donors(age 23) be bad? All the sperm be bad? Not one good swimmer?I finally insisted on taking flagle(sp) and it helped with the irratation during intercourse, but not to the suggestion of my doctor, a girlfiend doing ivf with another doc in LA
suggested we try it and it worked. I have more frozen eggs from the donor left but I feel that since they were so slow to multiply4-6 cells, they are just not worth it.iNow,it could be partly my eggs because of age and 9-13 fsh levels(41 age)+ the sperm issue but ...I think there is more and no one has given me any other ideas or options? Sad to say I am giving up. I did not miscarry
all my pregnancies so God can not be punishing me for my bad luck(preg on pill 2x) etc. Any thoughts on what to do. I am adopting and thinking of just less invasive cycle and even sperm donor? Thoughts and advise anyone?

Have you been tested for immunological problems (e.g. high levels of Natural Killer (NK) cells and/or abnormal activation of NK cells)? With your history of tubal pregnancies and premature labor, immunological problems may be present that inhibit or prevent implantation.